title: Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy?
abstract: BACKGROUND
  Periacetabular osteotomy (PAO) enables correction of bony acetabular deficiency in the setting of hip dysplasia. Patients with insufficient acetabular coverage often have intraarticular pathology, but the degree of this pathology has been incompletely characterized. We have used arthroscopy as an adjunct to PAO to further delineate intraarticular pathology in patients with hip dysplasia with mechanical symptoms.
  
  
  OBJECTIVE
  We documented the arthroscopic incidence of (1) femoral and acetabular chondral pathology, (2) femoral neck cam lesions, and (3) internal snapping or ligamentum teres pathology among patients having arthroscopy before PAO.
  
  
  METHODS
  We reviewed all 16 patients (17 hips; mean age at surgery, 21 years; range, 12-33 years) with hip dysplasia who underwent PAOs and concomitant hip arthroscopy at our institutions from October 2010 to March 2012. During this period, 80 patients underwent PAOs, making the arthroscopic cohort 21% of the total cohort. Indications for concomitant hip arthroscopy were mechanical symptoms consistent with labral pathology identified on MRI. We documented pathology involving the labrum, chondral surface, ligamentum teres, cam deformity, and psoas tendon.
  
  
  RESULTS
  Arthroscopy revealed significant intraarticular pathology in all patients. Fourteen hips had anterosuperior labral tears, and three hips had preoperative findings of internal snapping hip. Eleven hips had femoral cam-type lesions in addition to dysplasia, and 16 hips had articular chondral injury. Two hips had full-thickness ligamentum tears, and 13 hips had partial-thickness tears.
  
  
  CONCLUSIONS
  Intraarticular pathology at the time of PAO is common. Future studies are needed to rigorously address the use of arthroscopic intervention during PAO and the impact on clinical outcome compared to PAO alone.
authors.affiliation: Hinsdale Orthopaedics, Hinsdale, IL, USA.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Domb
authors.forename: Justin M
authors.initials: JM
authors.lastname: Lareau
authors.forename: Hasan
authors.initials: H
authors.lastname: Baydoun
authors.forename: Itamar
authors.initials: I
authors.lastname: Botser
authors.forename: Michael B
authors.initials: MB
authors.lastname: Millis
authors.forename: Yi-Meng
authors.initials: YM
authors.lastname: Yen
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D001182:Arthroscopy; D002648:Child; D005260:Female; D005269:Femur / Q000473:pathology / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult